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CPJE
Name tags - correct answer 1. 18 point font
- worn at all times at work
- State: Name and License Status PIC - correct answer 1. strict liability for violation of laws
- may supervise up to 2 pharmacies
- the 2 pharmacies MUST be w/in 50 driving miles
- any change of PIC must let the board know in writing within 30 days
- PIC canNOT be both a PIC and Designated Representative-in-charge (DRIC) for a wholesaler or vet food-animal drug retailer Biennial self-assessment form - correct answer completed by PIC when
- every odd # year before July 1st (QOY)
- within 30 days of pharmacy receiving a new permit
- within 30 days if the pharmacy has a new PIC Self-assessment kept on site for 3 years Pharmacist Breaks - correct answer 1. 30 min
- can only dispense refills that have already been checked by the pharmacist Can NOT dispense initial fills/New Rx's while pharmacist is NOT there
SB493 (p. 16) - correct answer Now can:
- Administer drugs and biologics
- Furnish self-administered hormonal contraceptives
- Furnish travel medications
- Furnish Rx nicotine replacement products
- Independently initiate and administer immunizations (> 3 yrs old)
- Order and interpret tests
- Administer drugs and biologics - correct answer 1. must be ordered by a prescriber
- all routes of drug admin. (i.e. topical and injectable)
- Furnish self-administered hormonal contraceptives - correct answer 1. oral formulations
- transdermal patch
- Vaginal ring
- Injection (depo provera)
- Furnish travel medications - correct answer recommended by CDC and that do NOT require a diagnosis
- Furnish Rx nicotine replacement products - correct answer nicotine replacement products --inhaler (Nicotrol) --Nasal spray (Nicotrol NS)
- Order and interpret drug therapy related tests
- Refer pts to other healthcare providers
- participate in the evaluation and management of patients w/ other HCP's
- Initiate, adjust, and d/c drug therapy pursuant to a protocol (if APP is adjusting or initiating controlled substance therapy they need to be registered w/ the DEA) APP requirements - correct answer 1. Earn a certificate in a relavent area of practice
- complete a residency
- Provide clinical services to pts for 1 year under a CPA or protocol w/ a physician, APP pharmacist or pharmacist practicing under a collaborative practice agreement A pharmacist can supervise _________ interns at a time (p. 19) - correct answer 2 Intern pharmacist - correct answer 1. all functions of a pharmacist
- caNOT have a key to the pharmacy
- All Rx's filled by an intern MUST be checked by a pharmacist Pharmacy technician - correct answer Can perform "Non-discretionary" tasks --can not include the ability to make decisions according to the technician's judgement
- removing drugs from stock
- counting
- pouring or mixing pharmaceuticals
- placing product into containers
- Applying labels Tech-Check-Tech Program - correct answer Pharmacists need to check Tech fills unless:
- Tech-Check-Tech program
- Acute care hospital with ongoing clinical pharmacy program
- pharmacists must be located in pt care areas
- medication orders must have been previously approved by a pharmacist Tech canNOT approve orders, ONLY can confirm the accuracy of the filling Pharmacist must still check all:
- compounded or repackaged drugs Pharmacist to staff ratios (p. 20) - correct answer Pharmacist to Intern: 1 pharmacist to 2 interns Pharmacist to Technician: Outpatient: --1 tech for first pharmacist --2 techs for each additional pharmacist (2 pharmacists = 3 techs) (3 pharmacists = 5 techs)
The agent can also prepare an Rx for the prescriber to sign and date Prescribing authority (Dentist) - correct answer independent authority CII - CV, limited to scope of practice Req DEA license Prescribing authority (Podiatrist) - correct answer independent authority, limited to scope of practice CII - CV, limited to scope of practice Req DEA license Prescribing authority (Veternarian, DVM) - correct answer independent authority, limited to scope of practice CII - CV, limited to scope of practice Req DEA license Prescribing authority (Optometrist) - correct answer independent authority, limited to scope of practice
- must be certified w/ the board of optometry to prescribe drugs
- Letter "T" at the end of their license number
- Codeine or Hydrocodone containing drugs: 3 day supply maximum - require a DEA number
- can prescribe other drugs: Abx, eye drops etc
Prescribing authority (Naturopathic Doctors, ND) - correct answer independent authority, limited to scope of practice Limited to the following:
- Epinephrine
- Natural and synthetic hormones (need DEA to Rx controlled substances such as Testosterone)
- vitamins, minerals, aminoacids, i.e. things available w/OUT a prescription
- All other non-controlled drugs and schedule III-V if registered w/ the DEA and under physician protocol Must have NDF by furnishing number in order to prescribe meds -provided by the bureau of naturopathic medicine Prescribing authority (Pharmacist) - correct answer independent authority Limited to the following:
- EC
- self-admin hormonal contraception
- Travel meds rec by the CDC, NOT requiring a diagnosis
- Routine immunizations rec by the CDC for 3+ years old
- Naloxone
- Prescription nicotine replacement products Dependent Authority all other drugs w/ protocol in place must register w/ DEA if Rx'ing controlled substances
If pt starts to see a new prescriber, the pharmacist should request a new Rx from the new prescriber Out of state prescriptions (p. 23) - correct answer Can fill a drug or device pursuant to a written or oral order from a prescriber licensed outside of California Pharmacist CAN dispense the prescription DIRECTLY to the patient Controlled substances Out of country presciptions - correct answer do NOT fill from out of county Can fill from US territories:
- Puerto Rico
- Virgin Islands
- Guam
- American Samoa Rx's must contain: (Written, oral, fax) - correct answer 1. Name of pt
- Address of pt
- Name and Quantity of drug/device
- Directions for use
- Date of issue
Prescriber info required on a Rx
- can be rubber stamped, typed, or printed by hand or typest
- Name, address, phone #
- Prescriber DEA# if controlled
- Prescriber's signature
- Conidition for which the drug is being prescribed IF the pt requests Veternarian
- if controlled substance must include kind of animal + name and address of owner Orally Transmitted Prescriptions (p. 24) - correct answer Received and reduced to writing ONLY by:
- Pharmacist
- Pharmacist intern "reduce to writing": write the oral Rx onto the pharmacy's prescription blank, whoever took the the Rx over the phone MUST initial the Rx and if dispensed by another pharmacist that pharmacist also initials the Rx Faxed Prescriptions (p. 24) - correct answer 1. received ONLY from prescriber's office - not from pt's home
- Reduced to a "hard copy" Internet Prescriptions (p. 24) - correct answer ONLY dispensed to the pt if the prescriber has PERFORMED an examination
PRN Refills - correct answer Are accepted in California for NON-controlled substances Should expire 1 year after the date written do NOT fill prn refills 1 year after the date written amount of times refilled depends on day's supply (bottom p. 25) Emergency Refills w/out Rx (p. 26) - correct answer Schedule III - V can be refilled w/out prescriber's authorization if prescriber is unavailable and in pharmacist's judgement the failure to refill the Rx might interrupt the patient's ongoing care and have significant effects on the pt's well-being must make every reasonable effort to contact the prescriber Must document the emergency fill must notify the prescriber w/in a reasonable amount of time CA does NOT define a specific number of days supply on an emergency fill non-schedule drugs - can provide up to the full fill schedule drugs III-V - only provide reasonable amount to cover the emergency period NO refills for Schedule II drugs Converting a 30-day supply into a 90-day supply
(p. 26) - correct answer 1. Non-controlled, non-psychiatric drug
- the pt has completed the initial 30 day supply with NO negative effects
- the total quantity dispensed including refills does NOT exceed the amount authorized on the prescription
- pharmacist must notify the prescriber Rx Transfers (p. 27) - correct answer Required info:
- Name of pharmacy
- original date and last fill date
- number of refills remaining Labeling requirements for refills (p. 28) - correct answer 1. Drug name
- directions for use
- Name of the pt
- Name of prescriber
- Date of issue/date Rx was written
- Name and address of pharmacy
- Rx number
- Strength of drug
- Quantity of drug
- Expiration date of the drug
- condition or purpose of the drug (if written on the prescription must also be on the label)
- Physical description of the drug (color, shape, imprint Expiration Dates (p. 28) - correct answer Expiration date can be:
Child Resistant Packing (p. 30) - correct answer PPPA (poison Prevention Packaging Act) Enforced by Consumer Product Safety Commission Child resistant caps - prevent children 5 and younger from opening med bottles NEW bottle and child-resistant cap needs to be used for EACH Rx dispensed The PRESCRIBER can WAIVE the requirement for the patient if they request an "easy open container" - per Rx The PATIENT can sign a waiver for ALL Rx's and can have all Rx's in an easy to open container Patient Medication Profiles - correct answer Pt's who rill Rx's at that pharmacy must be kept on file UNLESS the pharmacist feels that the pt will never return Pt profiles to include:
- Pt's Full name, address, phone #, DOB, Gender For each medication on the pt's profile:
- Name, strength, dosage form, route of admin, quantity and directions
- Prescriber's name, license #, DEA (if needed)
- Date drug was dispensed or refilled
- Rx # Pt medication record will be kept for 1 year from the date when the last Rx was filled Types of Written Patient Information - correct answer 1. Consumer Medication Information (CMI) --NOT reviewed by the FDA --purpose: to supplement oral counseling
- Patient Package Inserts (PPI) --for all estrogen-containing drugs --Hospital or long-term care: before admin and every 30 days
- Medication Guides (MedGuides) --FDA approved pt handouts that come with many prescription medications --manufacturer's MUST supply the pharmacies w/ Medguides (physical or electronic so pharmacy can print out the medguides for pts) MedGuides MUST be given out when: (p. 33) - correct answer Outpatient:
- Every time an initial fill and refill in an outpatient setting, when the drug will be taken by the patient without the supervision of a HCP
- First time drug is being dispensed to a healthcare provider for admin to a pt in outpatient clinic etc.
- Whenever a pt/caregiver asks for it
- If the drug is part of a REMS program
- Precautions and relevant warnings --common, severe adverse effects --interactions that can occur
- Importance of compliance with the medications May also include in pt counseling - correct answer 1. name and description of the drug
- route of admin
- dose
- duration of therapy
- What to do if a dose is missed Mailed Rx's and counseling (p. 37) - correct answer 1. Must provide a LETTER saying that the pharmacist is available if the pt has any questions + phone number for pt to call Counseling to pts who do NOT speak English (p. 37) - correct answer 1. MUST have interpretive services during all hours
- Employee or 3rd party Notice to Consumers (p. 37) - correct answer Purpose: to let pt's know they have certain rights
- Right to receive counseling
- right to ask questions
- Easy-to-read type
- Interpreting services
Must be in Public View Can order posters on Board's website Health Insurance Portability and Accountability Act (HIPAA) (p. 40) - correct answer All personnel involved with PHI have to have documented HIPAA training fines up to 50,000 + 10 yrs in prison for each HIPAA violation Only obtain the "minimum necessary" info required for the job (p. 41) It is Permissible to share PHI with: (p. 41) - correct answer 1. the Patient
- other HCP's providing care to the pt
- Tx, payment, or operation (TPO) purposes
- Other persons authorized by the pt
- Public health and institutional operations (limited data search)
- for a public health need HIPAA requires SITE SPECIFIC privacy notices - correct answer Must be give to the pt on the 1st day service is provided NO requirement for future signatures If pt refuses to sign:
- Pharmacy canNOT refuse services to pt
- Just document pt's refusal
